14060204 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 201 If STEVENS CREEK BLVD CONTRACTOR:DOUBLE ED PERMIT NO: 14060204
CONSTRUCTION INC
OWNER'S NAME: TRANS-CONTINENTAL REAL ESTATE INVS 189 BELEVUE AVE DATE ISSUED: 10/01/2014
OWNER'S PHONE: 4089963399 PARTY CITY,CA 94014 PHONE NO:(415)420-8145
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
SUITE#150-CHANGE OCCUPANCY FROM B TO E TO
License Class___ Lic.# �� �/ Ob' CONVERT
Contractor r � �� Date JZ OFFICE SPACE TO MONTESSORI PRESCHOOL.
1 hereby affirm that I am licensed under the provisions of Chapter 9 deferred installation of new play structure-issd ote 12/22/2014
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect. 1 `
1 hereby affirm under penalty of perjury one of the following twVA
ons: `. N
I have and will maintain a certificate of consent to self=insuret Wrer's \2
Compensation,as provided for by Section 3700 of the Labor Cne,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$200000
1 have and will maintain Worker's Compensation Insurance,as pr for by
ction 3700 of the Labor Code,for the performance of the work for which this
APN Number:31623026.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMITEXP F WORK IS NOT STARTED
correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 1804
8 AYS PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY R M LAST CALLED INSPEC IO
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /
costs,and expenses which may accrue against said City in consequence of the /
granting of this permit.Additionally,the applicant understands and will comply Issued by: Date: L'I
with all non-point source regulations er the Cupertino Municipal Code,Section
9.18.
�2Z/ RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.if a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533, 25534.
Section 3700 of the Labor Code,for the performance of the work for which thisr
permit is issued. Owner or authorized agent: Date:
1,2 1 certify,that in the performance of the work for which this permit is issued,1 shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20111 STEVENS CREEK BLVD CONTRACTOR:DOUBLE ED PERMIT NO: 14060204
CONSTRUCTION INC
OWNER'S NAME: TRANS-CONTINENTAL REAL ESTATE 1NVS 189 BELEVUE AVE DATE ISSUED:10/01;2014
OWNER'S PHONE: 4089963399 PARTY CITY,CA 94014 PHONE NO:(415)420-8145
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
SUITE 4150-CHANGE OCCUPANCY FROM B TO E TO
License Class _ Lic.# (/ CONVERT
Contractor � Date /b 'l OFFICE SPACE TO MONTESSORI PRESCHOOL.
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$200000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
APN Number:31623026.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES S IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF T ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save Igo DAYS FR ALLE TION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the /Q
granting of this permit. Additionally,the applicant understands and will comply 1 ate:
with all non-point source regulation per the Cup rtino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date `� All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections,25505,2553 ,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Q
Owner or authorized agent: Dater
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
-
I certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes_(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20111 STEVENS CREEK BLVD CONTRACTOR:DOUBLE ED PERMIT NO: 14060204
CONSTRUCTION INC
OWNER'S NAME: TRANS-CONTINENTAL REAL ESTATE INVS 189 BELEVUE AVE DATE ISSUED: 10/01/2014
OWNER'S PHONE: 4089963399 PARTY CITY,CA 94014 PHONE NO:(415)420-8145
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
Q _ [y SUITE#150-CHANGE OCCUPANCY FROM B TO E TO
License Class Y Lic.# 0- O CONVERT
Contractor �Dubl I 6 OFFICE SPACE TO MONTESSORI PRESCHOOL.
a REV#1 -SWAP RESTROOM LOCATIONS,ADD
I hereby affirm that I am licensed under the provisions of Chapter 9 ACCESSIBLE RAMP&STEPS/RISERS W/HANDRAILS-
(commencing with Section 7000)of Division 3 of the Business&Professions ISSUED 11/6/14
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$200000
I have and will maintain Worker's Compensation Insurance,as provided for by
ction 3700 of the Labor Code,for the performance of the work for which this
APN Number:31623026.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS MIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter .--
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS LLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issue te: 11A
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date ��" All roofs shall be inspected prior to any roofing material being installed.if a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(See.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2553 and 2553
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:
permit is issued.
1 certify that in the performance of the work for which this permit is issued,l shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,) CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct, l agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20111 scb suite 150 DATE: 06/30/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$200,000
„PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1E TI
USE: PERMIT TYPE:
WORK chap a occupancy from b to e to convert offices ace to montessori preschool.
SCOPE
TYPE OF FLR AREA
OCCUPANCY TYPE: CONSTR. (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID
E (Tenant Improvements) II-B,III-B,IV,V-B 4,860 $4,513.07 IETIPLNCK $5,794.29 IETIINSP
TOTALS: 4,860 $4,513.07 $5,794.29
MECH,HOURLY 0 Yes" (D No PLUMB,HOURLY Q Yes (2) No ELEC,HOURLY 0 Yes (F)No
Lj
El
NOTE. This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fiees are based on the preliminar information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $4,513.07 Select a Misc Bldg/Structure
Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Pennit Fee: $5,794.29
Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Pen-nit Fee: $0.00
Work Without Pen-nit? 0 Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential (2)
Building or Structure
Strong Motion Fee: IBSEISMICO $42.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $8.00
SUBTOTALS: $10,357.361 $0.00 TOTAL FEE: $10,357.36
Revised: 04/01/2014
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 20111 scb DATE: 1212212 14 REVIEWED BY: Mendez
APN: BP#: v `VALUATION: 1$25,000
`PERMIT TYPE: Building Permit PLAN&ECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1 GENCOM
USE: PERMIT TYPE:
WORK deferred #1 installation of new play structure
SCOPE
Lj
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l in o.
FEE ITEMS (Fee Resolution II-053 EV 7"1%13) FEE QTY/FEE MISC ITEMS
Pian Check Fee: $0.00 L'J # Deferred Submittal
Suppl. PC Fee: E) Reg. Q OT 0.0 hrs $0.00 $286.00 IDEFSUBM
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. ® OT Q,Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? Q Yes C!) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure 0
Strom Motion Fee: IBSEISMICO $7.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $8.00 $286.00 TOTAL FEE: $294.00
Revised: 10/01/2014
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20111 STEVENS CREEK BLVD DATE: 11/06/2014 REVIEWED BY: MELISSA
APN: 31623026.00 BP#: `VALUATION: $0
-PERMIT TYPE: Building Permit PLAN CHECKTYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1 GENCOM
USE: PERMIT TYPE:
WORK �=/HANDRAILS
# 1 - SWAP RESTROOM LOCATIONS ADD ACCESSIBLE RAMP & STEPS/RISERS
SCOPE - ISSUED 11/6/14
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (l=ee Resolution 11-053 Eff 711!13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 1 hours Plan Check, Hourly
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $143.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? ®Yes D No $0.00
Suppl. Insp. Fee.0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? ® Yes Q) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure
Strong Motion Fee: $0.00 1.0 hrs Inspections
Bldg Stds Commission Fee: $0.00 $143.00 ISTLVSP Inspection,Hourly
SUBTOTALS: $0.00 $286.00 TOTAL FEE: 1 $286.00
Revised: 1010112014